Traumatic Anterosuperior Rotator Cuff Tears: The Outcome of Open Surgical Repair

Namdari, Surena; Henn, III, R. Frank; Green, Andrew
September 2008
Journal of Bone & Joint Surgery, American Volume;Sep2008, Vol. 90-A Issue 9, p1906
Academic Journal
Background: Anterosuperior rotator cuff tears involving the subscapularis and supraspinatus tendons are less common than posterosuperior tears and are rarely discussed in the literature. The purpose of this study was to identify the unique features of this injury and to assess the outcome of operative treatment. Methods: Thirty consecutive patients, with a mean age of fifty-seven years (range, forty-three to seventy-three years), had an open repair of a traumatic anterosuperior rotator cuff tear. Twenty-four patients (80%) were male. Sixteen patients (53%) had involvement of the dominant shoulder, twenty-three (77%) had a biceps tendon disorder, and sixteen (53%) had a positive lift- off maneuver prior to surgery. Surgical approaches included an isolated superior deltoid-splitting approach in twenty patients, an isolated deltopectoral approach in five patients, and a combined approach in five patients. Open repair was performed at a mean of 4.5 months after the injury or the onset of symptoms. The final outcomes were determined with a physical examination and patient self-assessed outcome tools. Results: At a mean follow-up of fifty-six months, twenty-one of the thirty patients were satisfied with their symptoms, and twenty-nine would have the surgery again. The mean pain score on the visual analog scale improved from 6.2 to 1.2 (p < 0.001). The mean score on the Disabilities of the Arm, Shoulder and Hand questionnaire improved from 41.7 to 12.2 (p < 0.001). The mean percentage of functions that patients were able to perform on the Simple Shoulder Test improved from 36.4% to 82.8% (p <0.001). The mean age and sex-adjusted Constant score was 93.4 postoperatively. The mean elevation, external rotation, and internal rotation of the involved shoulders were 97%, 109%, and 97%, respectively, of those of the contralateral side. The mean strength of elevation, external rotation, and internal rotation were 85%, 93%, and 101%, respectively, of those of the contralateral side. Infraspinatus involvement (p = 0.04), the extent of the supraspinatus tear (p = 0.03), and a Workers' Compensation claim (p = 0.03) were associated with worse outcomes and decreased satisfaction. Conclusions: Patients with a traumatic anterosuperior rotator cuff tear present with internal rotation weakness, and they usually have a biceps tendon disorder. While larger tears involving greater portions of the supraspinatus and extending into the infraspinatus are associated with poorer outcomes, early recognition of this injury and open repair can reliably restore shoulder function to near normal levels.


Related Articles

  • Hemiarthroplasty for the Rotator Cuff-Deficient Shoulder. Goldberg, Steven S.; Bigliani, Louis U. // Journal of Bone & Joint Surgery, American Volume;Mar2009 Supplement, Vol. 91-A, p22 

    BACKGROUND: Hemiarthroplasty is a common treatment for cuff tear arthropathy and glenohumeral arthritis associated with a massive tear of the rotator cuff; however, to our knowledge, long-term outcomes and preoperative factors affecting results have not been reported. METHODS: Thirty-four...

  • rhBMP- 12 Accelerates Healing of Rotator Cuff Repairs in a Sheep Model. Seeherman, Howard J.; Archambault, Joanne M.; Rodeo, Scott A.; Turner, A. Simon; Zekas, Lisa; D'Augusta, Darren; Li, X. Jian; Smith, Erica; Wozney, John M. // Journal of Bone & Joint Surgery, American Volume;Oct2008, Vol. 90-A Issue 10, p2206 

    Background: The success rate of rotator cuff repairs is variable. This study was performed to evaluate the ability of recombinant human bone morphogenetic protein-12 (rhBMP-12), administered in several carriers, to accelerate healing in a sheep model of rotator cuff repair. Methods: Local...

  • The Outcome and Structural Integrity of Arthroscopic Rotator Cuff Repair with Use of the Double-Row Suture Anchor Technique. Lafosse, Laurent; Brzoska, Roman; Toussaint, Bruno; Gobezie, Reuben // Journal of Bone & Joint Surgery, American Volume;Oct2008 Supplement 2, Vol. 90-A, p275 

    BACKGROUND: The reported rate of failure after arthroscopic rotator cuff repair has varied widely. The influence of the repair technique on the failure rates and functional outcomes after open or arthroscopic rotator cuff repair remains controversial. The purpose of the present study was to...

  • Tendon Integrity and Functional Outcome After Arthroscopic Repair of High-Grade Partial-Thickness Supraspinatus Tears. Kamath, Ganesh; Galatz, Leesa M.; Keener, Jay D.; Teefey, Sharlene; Middleton, William; Yamaguchi, Ken // Journal of Bone & Joint Surgery, American Volume;May2009, Vol. 91-A Issue 5, p1055 

    Background: Partial-thickness rotator cuff tears are a common cause of shoulder pain, yet the appropriate surgical treatment is controversial. In particular, very little information is available regarding rotator cuff integrity after operative repair. The purpose of this study was to evaluate...

  • Mini-Open Rotator Cuff Repair Improved Quality of Life at 3 Months.  // Journal of Bone & Joint Surgery, American Volume;Feb2009, Vol. 91-A Issue 2, p494 

    The article reports on the results of research which was conducted in an effort to determine whether standard open acromioplasty with rotator cuff repair or arthroscopic acromioplasty with mini-open rotator cuff repair leads to a better quality of life for patients with full-thickness rotator...

  • The Use of an Intra-Articular Depth Guide in the Measurement of Partial Thickness Rotator Cuff Tears. Carroll, Michael J.; More, Kristie D.; Sohmer, Stephen; Nelson, Atiba A.; Sciore, Paul; Boorman, Richard; Hollinshead, Robert; Lo, Ian K. Y. // Advances in Orthopedics;2013, p1 

    Purpose. The purpose of this study was to compare the accuracy of the conventional method for determining the percentage of partial thickness rotator cuff tears to a method using an intra-articular depth guide. The clinical utility of the intra-articular depth guide was also examined. Methods....

  • 양측성 회전근 ê°œ 파열에 대한 수술적 치료 ê²°ì • 및 ê²°ê³¼. 장호진; 최창혁; 엄윤식 // Journal of the Korean Orthopaedic Association;Jun2013, Vol. 48 Issue 3, p213 

    Purpose: We evaluated the influencing factors in selection of initial operation and outcomes after operative treatment of symptomatic rotator cuff tear including both sides. Materials and Methods: From December 2000 to March 2011, 60 shoulders of 30 patients underwent arthroscopic rotator cuff...

  • Internal rotator and external rotator weakness associated with recurrent anterior instability. Owens, Colleen; Press, Robert // Orthopedics Today;Jun2011, Vol. 31 Issue 6, p20 

    The article focuses on a study led by P. Edouard and published in a 2011 issue of the "Journal of Bone and Joint Surgery" which found that recurrent anterior instability may lead to weakness in the internal and external rotator, with side-to-side differences depending on the side of hand dominance.

  • Shoulder Resurfacing. Burgess, Derrick L.; McGrath, Mike S.; Bonutti, Peter M.; Marker, David R.; Delanois, Ronald E.; Mont, Michael A. // Journal of Bone & Joint Surgery, American Volume;May2009, Vol. 91-A Issue 5, p1228 

    ...Resurfacing is a type of shoulder arthroplasty that involves replacing the humeral joint surface with a metal covering, or cap, thus preserving the bone of the proximal part of the humerus. If the glenoid is also replaced, a current conventional polyethylene glenoid replacement prosthesis or...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics